Saturday, June 5, 2010

Short Essays from the ER.

These aren't sexy, sorry, but I just wanted a place to write them.

Gray GooOne part of my job is taking patients to CT scans. I move them onto the table, position them and strap them in as needed, and retreat into a little leaded-glass cubicle with the CT operator while the scan takes place. The weekday operator is a big, thuggish-looking but friendly guy with a heavy Baaahstan accent, and he points out relevant anatomy as we watch the slices of the person's body appear one by one on the monitor. There are the kidneys, the lungs with blood vessels in a spidery tree through them, the intestines in their massive coils, each bone white and sharp on the scan.

And there is the brain. Scanning from the top of the skull, the first thing you see after bone is the wrinkles of the surface, the sulci and gryi, like a bowlful of thick noodles in the head. Then there's just... solid, just a gray hunk of stuff, and then the ventricles, little lakes of fluid deep inside the brain. Then more stuff of no particular character, and then you're down to the spine. The full scan looks like this. It only takes a single swipe of the operator's mouse to scroll through the entire brain.

Afterwards I go back out to help the patient off the table, and I talk to them. They tell me how they're feeling, what they're thinking, they make little jokes, they recall how they got hurt, they worry about the future, they gripe about how long all these hospital things take. It seems unimaginable, impossible to me that all this comes out of a single mouse-swipe's worth of gray goo. The old lady saying "bless you, dear" even though she's in pain, the argumentative drunk saying he really doesn't need this but fine he'll do it, the scared little kid trying to be brave with tears in the corner of her eyes--all that comes out of that little chunk of gray goo.

I can't help thinking that there's something the CT can't scan. Not in the fuzzy "soul" sense, I mean literally. Seeing someone from head to toe on the inside, there doesn't seem to be enough in there to explain them. Everything inside a person can be seen and named, every inch of their body laid bare to X-rays and educated minds, but I always think there's something held back. What I can see just looks too simple. The part that explains it isn't in there.

I see everything inside a person's head, then go out and talk to them, and I realize that I have not seen their mind.

Post-Traumatic Rest and OrderAnother part of my job is cleaning up after traumas. I have a role during the traumas too, but there's not much room for contemplation then. There's a grim little joke in EMS: "Bleeding always stops." Trauma always ends, one way or another, and the room empties out. The patient goes to surgery or up to a room or down to the morgue, and the doctors and nurses go on to other tasks, and I'm the only one left in the room.

It's very quiet then. I can take my time. There's aftermath everywhere; all the packaging for bandages and needles has been dropped where it was opened, and the unwrapped bandages are still open on the bed. There's a big knot of linens on the bed, warmed blankets and absorbent sheets. All the machines and carts and toolkits that were used on the trauma lie around the room. And there's blood. Blood on the bed, the floor, the linens, the equipment. Sometimes there's stuff besides blood.

It takes about fifteen minutes to make it all shiny again. I start by putting the machines back, because another patient might need them; I wipe them down with antiseptic, roll them to tidily labeled cubbyholes, and plug them back in to charge for the next time. The next step is picking up all the trash, a frat-house's worth of plastic and paper and junk on every surface. I make sure there aren't any needles or other surprises in the linens and roll them into a plastic bag for the laundry. I clean the bed and all surfaces with disinfectant, wiping the blood away, as if nothing had ever happened. Everything is non-porous, plasticized, stain-resistant, so it's easy work; the room is made to forget. The last step is to make the bed and set it up for the next patient.

Cleaning up after a trauma is silent and solitary in every way that the trauma was not. My task is to restore functionality and cleanliness, of course, but it also serves to wipe away memory. A clean trauma room looks like nothing bad ever happened there; the screams do not absorb into the walls, the pain does not soak into the bed. As I pull a fistful of wipes across a bloody mattress, there is horror and drama ahead of my hand, and nothing behind it. Just wet plastic. Leave it wet for five minutes and it will be purged of 99.9% of pathogens. It'll just be plastic. Ready for the next one.

I like cleaning up after traumas. It's like I'm restoring all the order in the world. My hands take away everything painful and dirty and messy, and leave only those things that humans intended. The dirty trauma room is a creation of circumstance and chaos; the clean one is a product of careful planning and best intentions. A clean trauma room, antiseptic and filled with brilliant technology conveniently laid out, is everything that people want the world to be. I love creating that place. The trauma room is a perfect little outpost of humanity in the wilderness, until chaos comes again.

Well, if you go with the overused computer metaphor, just looking at the pyshical aspects of the brain is like looking at the CPU and hard drive. But the computer is far much more than just that. Both are largely irrelevant without the other parts (the case, the power box, the keyboard, the monitor, etc.). And even all those things are irrelevant without various pieces of software, which in modern computers is probably more complicated than the hardware. And even that doesn't take into account that knowing what most of the individual parts in the CPU and Hard Drive do in a general sense doesn't say very much about what it's like to use an actual computer as a whole entity.

So no, when you see just the physical structure of the brain, you're definitely not seeing who they are as a full person.

Very awesome post! In relation to the brain, the CT scan is only showing you structures at a size scale that is way larger than the fundamental unit of information processing, which are synapses, and which are on the order of one millionth of a meter in diameter. There are trillions of synapses in the human brain, and that provides the complexity required to produce such intricate cognitive function.